Democrats’ Latest Campaign for Health Care Law Begins

Representative Michael C. Burgess, Republican of Texas and a critic of the health care law, said, “There has to be a Plan B.”Credit
J. Scott Applewhite/Associated Press

WASHINGTON — President Obama and congressional Democrats, seizing on the good news of an improving health care website and rising enrollments, on Wednesday highlighted parts of the law that are popular with the public and reminded Americans, and the law’s opponents, of what would be lost if the Affordable Care Act were repealed.

As part of that political counteroffensive, which began this week, Democratic congresswomen challenged Republicans to present an alternative that would provide free preventive health services for the 105 million Americans who have already received them under the law. At the same time, the Democratic Congressional Campaign Committee singled out about 60 House Republicans, accusing them of plotting to take away immunizations for children, cancer screenings and mammograms.

The president’s aides said that with fixes in place online, they hoped a daily barrage of more positive messages about the health care law during the next several weeks — some to be delivered by Mr. Obama personally — would help refocus attention on its benefits. Mr. Obama addressed a White House Youth Summit meeting on Wednesday, and on Thursday he will talk about how the law prohibits insurance companies from discriminating against people with pre-existing medical conditions.

“Every day, there will be something coming out of the White House,” said one official, who was not authorized to talk publicly about the strategy and spoke on the condition of anonymity.

White House officials and congressional Democratic leaders said the effort was intended to get rank-and-file Democrats out of the defensive crouch they had been in for the past two months by countering the barrage of negative stories from Republicans. The push comes amid reports of a surge in enrollments since the administration announced improvements in the performance of the federal marketplace. About 29,000 people selected insurance plans on HealthCare.gov during the first two days of December, 3,000 more than the total who signed up over the whole month of October, according to people familiar with the numbers.

The battle over the president’s signature domestic achievement is far from over, but this week, for the first time since the rollout of HealthCare.gov on Oct. 1, Democrats seem prepared to fight.

Three weeks ago, House Democratic “strike teams” initiated a daily morning conference call to go over health care messages. On Wednesday, more than 40 congressional aides, including Senate aides and administration officials, had joined.

House Democrats have begun passing along positive stories in their districts — of constituents obtaining insurance for the first time and gaining access to preventive care — during coordinated morning speeches that have become dueling anecdotes from the health care wars. On Thursday, members will focus on pre-existing conditions; next week, the theme is Medicaid expansion.

Even some Republicans are grudgingly saying that the health care law is already too established for a wholesale repeal, and with thousands of uninsured signing up daily, that option grows more distant each week.

“It’s not in dispute that many Americans’ lives are being disrupted in an important way by this law,” said Representative Scott Rigell, Republican of Virginia. “Is it also true that some Americans’ lives have gotten better? Yes, and to not acknowledge that is to deny reality.”

The health care law, he said, needs “more of a course change than a course reversal.”

But even with the glimmers of good news, the law faces enormous challenges. A poll conducted last month and released Wednesday by the Harvard University Institute of Politics found that a solid majority of Americans between the ages of 18 and 29 — a constituency crucial to the success of the health law — disapproved of the law and among the 22 percent of that age group who did not have insurance, only 29 percent said they would definitely or probably enroll.

The Obama administration was counting on seven million enrollees by the end of the first enrollment period in March, a number that was supposed to ensure a safe mix of sick, older people and young, healthy ones. Because of problems with the federal insurance exchange and the negative publicity around the rollout, the total is likely to be well short of that.

Representative Dave Camp, Republican of Michigan and chairman of the Ways and Means Committee, said the administration needed to be enrolling close to 100,000 people a day to meet its target. Because state-based websites are doing better, other calculations put the necessary number closer to 40,000 a day, but few are suggesting the goal of seven million is within reach.

“A year from now, if you’ve got too many people to kick it down and not enough to make it work, clearly, there has to be a Plan B,” said Representative Michael Burgess, Republican of Texas and an ardent critic of the law.

White House officials said such prognostication was premature. The experience of Massachusetts under Gov. Mitt Romney showed that most people, especially young people, acted only when they approached a deadline, and with the federal law, the deadline to have insurance or pay a penalty is months away. The officials argue that the total number of people who sign up for insurance is less important than the composition of those enrolled, and they pointed to state figures to suggest the mix was good. More than one-quarter of enrollees in Kentucky are 35 and younger. In California, 22.5 percent are between 18 and 34.

Because insurers on the exchanges cannot discriminate by pre-existing conditions, applications do not ask questions that would indicate the health of enrollees, said Cori Uccello, senior health fellow at the American Academy of Actuaries. So while insurers will know the ages of their new customers, they won’t know their health status until they start filing claims next year.

But the health law contains important provisions to prevent a “death spiral,” in which a population too heavily weighted to the old and sick drives up premiums, pushing healthier enrollees out, resulting in even higher premiums, said Stan Dorn, a senior fellow at the Urban Institute’s Health Policy Center.

Between 2014 and 2016, a temporary tax on health plans will pay for most of the claims of high-cost enrollees while lowering premium costs for everyone else. Over the same years, “risk corridors” ensure that health plans that collect far more in premiums than they pay out in benefits pay into a fund used to help plans that pay unexpectedly high benefit costs. A permanent feature mandates that health plans that enroll a disproportionate number of sick patients receive payments from plans that “cherry pick” a healthier population.

Most important, Mr. Dorn said, younger enrollees, who also tend to be less affluent, will receive tax subsidies. If premium prices spike, the government will absorb that cost, ensuring they do not flee the exchanges.

“Lower-than-expected enrollment probably will mean average risk levels will go up, but that’s not the end of the world,” he said.

A version of this article appears in print on December 5, 2013, on page A28 of the New York edition with the headline: Democrats’ Health Law Counteroffensive Is Up and Running. Order Reprints|Today's Paper|Subscribe